In September 2006,
the Centers For Disease control made a change in policy, asking for wide-spread
population screening to detect earlier people in the U. S. who are infected with HIV. See the lead
article in the Washington Post September
22, 2006; A01. “All adolescents and adults should routinely be
tested for HIV infection in hospitals, clinics and doctors' offices, the
federal government said yesterday, signaling a radical shift in the public
health approach to the 25-year-old epidemic.”

Why is this radical shift occurring now and not ten years ago
when effective antiretroviral treatment became available? Perhaps the medical
establishment was fooled by research published in 1994 and 1997 indicating that
broad testing would be ineffective at stemming the epidemic. Did those papers
make absurd assumptions to prove their point? Is it really possible that gay
men choose sex partners whose age differs from theirs by a median of 0.4 years?
If they could, why would they bother?

James Koopman et al (1) assert that in sexual contacts HIV-1
is most infectious when the infected partner is in the “first” stage of
infection, the initial two-month period before developing antibodies to HIV.
Hence the standard antibody detection tests will not work during that stage. For
an epidemic that is nearly level as in the United
States, their estimates imply that about 3/4
of all infections are caused by people in stage 1. Our paper (2) asserts that
the third stage is most infectious. Since the third stage typically begins
after about seven years of infection, there is sufficient time for population
screening to identify many infected individuals. The third stage (excluding the
AIDS stage) is typically about 12 times as long as the first stage so infected
individuals have more time to spread the disease in that stage than in the
primary stage.

If an infected person is detected,
he or she will, with high likelihood, begin treatment with anti-retroviral
drugs, and his or her infectiousness will plummet.

We believe that if the screening
policy is implemented effectively, many chains of infection, from person to
person to person ... will be stopped and the rate of new infections in the US
will be decrease significantly.

This paper observes that Koopman
& Simon believe their criticisms (though R-S-Y do not). These criticisms
are equally valid for attacking the K-S work. “Koopman and Simon ... seem to
severely criticize their own paper and choose not to defend itagainst our remarks.”Does Dr. Koopman believe that hypotheses
should be changed and shifted until the results are those he wants, even if it
is necessary to make absurd hypotheses?

The District will launch a campaign
next week urging every resident between the ages of 14 and 84 to be tested for
HIV, an ambitious undertaking that public health officials say is critical to
reversing rates of infection that are among the worst in the country.The citywide campaign, which
appears to be unprecedented in its breadth, will target 400,000 men, women and
teenagers and encourage them to learn their HIV status through an oral swab
that delivers results in 20 minutes. Organizers want the rapid test
to become as common a part of any medical exam as blood-pressure monitoring or
a cholesterol check. The hope is that the results, especially if positive,
would influence a person's sexual behavior and motivate him or her to seek
treatment.Nationally, the CDC estimates,
25 percent of the more than 1 million Americans living with HIV are unaware they
are infected.
Appleseed Executive Director Walter Smith applauded the campaign yesterday.
"I don't think you'll find routine citywide testing anywhere in the
country," he said. "It's an important and bold step forward, and we
welcome it."

A monograph that created a
theoretical underpinning for US policy on gonorrhea population screening
policy: